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M4 <br /> M M M 1F <br /> ANI)ANA1I SIS H1 QUESI 1)OCUMI:NI F,,I jAL <br /> CLIENT DETAILSI <br /> Client Rush Analysts 5 Days 2 Days 2his <br /> �ampier(5) � � V RRiJ 'f oT. Subject to surcharge e <br /> Cuslomer Number `w1I • '3�r QA/QC report required yes no <br /> Address w � Y <br /> L� (A ���D� — Electronic Data Transfer yes no <br /> A MAComp 5arnpler Set up Date Tlme <br /> If yes,To State— Cheat Other <br /> Phone 'a �' J � <br /> ��� �R I Tn3r� _Mllc.,lgt � _ Loh number -- <br /> 1 A X rllW{ <br /> ASAv1'a r� � �f Lab Loc SP ❑ STK ❑ VI <br /> a ❑ ❑ <br /> Protenamt [J[ CL ( r <br /> Contact person # 1T La. <br /> v <br /> Billing Informalwo(if diff milt trom aboVL) H^�, a u d <br /> Name y a o S 4 <br /> Address <br /> C7 p O d 0 <br /> ti/ R <br /> q 5 a g y Z v 0 <br /> Phone — O enFAX ^ <br /> .t F Q Ln t O Q �� fqIr <br /> Contact person04 �9 a m s A U u z w , <br /> Purthase urderkorwact/ML quole number _ o w C7 Oil <br /> p <br /> Pre Log Required yes _ no c7 z T o v Z_ Z d Q <br /> o <br /> U c c n F i V1 <br /> ' rEncl <br /> w U <br /> o a o 0 <br /> p u ry <br /> Sample Localion/Description Date Time n. }( 3 3 `nX d <br /> Number Sampled Sampled m U <br /> .. �6• I P <br /> r - <br /> CUSTODY <br /> Rctinyuw and�whtecl to rl launtllunrx un tha mvaru Dr INS dexunieni <br /> Date iV• �II rink_ y�hh� Rchnywshrtj by le Ti <br /> Rr�uved y D.aJC}" �� b Tilne1� k��} Rnerved by Date Time <br /> Rebnqut•hed 6y Dst Time_ Relinquished by Date Time <br /> Received by DAw Time Received by Date Time <br /> CORPORATE OFFICE LABORATORY OPENLY&LABORATORY FIELD OFFICE <br /> PO Boa 2721853 Corporalwn Slmet 25110%Ugcuwah Rn.d ViWik California <br /> Salim Nufa CA 91061 0272 Sliw tlmi f A IW IS Tel 120917H 9473 <br /> Salim <br /> I86SI n591r1In W ( WO] MSL Muhdc (2tiv)7372194 <br /> r ti 1 <br />